BURHAN HAKAN KANAT, ZEYNEP ÖZKAN, MEHMET BUĞRA BOZAN, Fadlı DOĞAN, Fatih EROL, Mesut YUR, Kazim DUMAN, Yılmaz POLAT, Selim SÖZEN, MEHMET BURAK DAL

Yaşlı hastalarda ventral herni tamirinde elektif cerrahiye karşı acil cerrahi yaklaşımın karşılaştırılması

Amaç: Yaşam süresinin ve beklentisinin artmasıyla yaşlı hastalar ile artık daha fazla karşılaşılmaktadır. Gelişen teknoloji ve tıbbi uygulamalar ile yaşlı hastalar daha rahat opere edilmekte ve morbidite-mortalite riskleri aynı oranda azalmaktadır. Çalışmamızda, insizyonel herni nedeniyle elektif ve acil olarak tedavi edilen ileri yaş hastaları değerlendirmek ve tedavi sonuçlarını karşılaştırmayı amaçladık. Gereç ve yöntem: Kliniğimizde Ocak 2012-Kasım 2014 tarihleri arasında, insizyonel herni tanısı konmuş ileri yaş hastaların dosyaları retrospektif olarak taranmıştır. Yaşı 65 ve üstü olan 38 hasta,acil ve elektif şartlarda opere edilenler olmak üzere iki gruba ayrılmış; Acil cerrahi yapılanlar Grup-I ve Elektif cerrahi yapılanlar Grup-II olarak belirlenmiştir. İki grup yandaş hastalıklar (kardiyak, pulmoner, endokrin ve diğer) ve komplikasyonlar (seroma,yara enfeksiyonu, ileus ve diğer) yönüyle karşılaştırılmıştır. Bulgular: On (% 26) hasta acil (Grup-I) ve 28 (% 74) hasta elektif cerrahi grubu (Grup-II) olarak tespit edilmiştir. Anestezi Skoru değerleri açısından iki grup arasında istatistiksel olarak anlamlı fark olmadığı bulunmuştur (p=0,27). Yandaş hastalığı olan 31 (% 78) hastanın 8(% 24)’i Grup-I ve 23(% 76)'ü Grup-II olarak görülmüştür (p=0,60). Yoğun bakım ihtiyacı gösteren 5(% 13,1) hastanın 4 (%10,5)’ü Grup-I ve 1 (%2.6)’i Grup-II olarak bulunmuştur (p=0,012). Dokuz (% 23,6) hastada komplikasyon gelişmiş, 3 (%7,9)’ü Grup-I, 6 (%15,7) hasta Grup-II olarak tespit edilmiştir (p= 0,44). Seroma toplam 3 (% 7,9) hastada vardı ve bunlardan 1 (% 2,6) hasta Grup-I ve 2 (%5,2) hasta Grup-II olarak bulunmuştur (p=0,61). Sonuç: Gelecekte, asemptomatik insizyonel hernili yaşlı olgularda acil veya elektif cerrahi işlemlere kıyasla, non- operatif gözlemin tercih edilebileceğini çalışmamız bize düşündürmektedir.

THE COMPARISON OF ELECTIVE REPAIR VERSUS EMERGENCY SURGERY IN THE ELDERLY PATIENTS WITH VENTRAL HERNIA

Objective: With the increase in life span and expectancy, elderly patients are more frequently encountered. Advanced technology and medical applications enabled the elderly patients to be operated more easily and reduced their morbidity and mortality risks at the same rate. We aimed to evaluate the elderly patients who were treated electively and emergently due to ventral hernia and to compare the outcomes of their treatments in this study. Material and Method: The files of the elderly patients who were diagnosed with ventral hernia in our clinic between January-2012 and November-2014 were screened retrospectively. Thirty-eight patients aged 65 years and over were divided into two groups as emergently (Group-I) or electively (Group-II) operated patients. They were compared in terms of comorbid diseases (cardiac, pulmonary, endocrine and other) and complications (seroma, wound infection, ileus and others). Results: Ten (26%) patients were determined as emergency (Group-I) and 28 patients(74%) as elective surgery group (Group-II).No statistically significant difference was found between two groups in terms of ASA values (p = 0.27). Of 31 patients (78%) with comorbid disease, eight (24%) were in Group-I and 23 (76%) were observed to be in Group-II (p = 0.60). Of five patients (13.1%) who required intensive care need, four (10.5%) were in Group- I and one (2.6%) was in Group-II (p=0.012). Complication developed in nine patients (23.6%) and three of them (7.9%) were classified as Group-I and six of them (15.7%) as Group-II (p = 0.44). Seroma was found in three patients (7.9%) and one of them (2.6%) was in Group-I and two patients (5.2%) were in Group-II (p = 0.61). Conclusion: Our study suggests that, in the future, non-operative observation may be preferred compared to emergency or elective surgical procedures for the elderly cases with asymptomatic incisional hernia.

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Kulah B, Duzgun AP, Moran, M, Kulacoglu I. H., Ozmen MM, & Coskun MF. Emergency hernia repairs in elderly patients. The American J of Surg 2001;182:455‐459.
Becouam G, Szmil E, Leroux C, Arnaud JP: Surgical cure of postoperative eventrations with intraperitoneal implantation of dacron mesh. Apropos of 160 operated cases. J Chir 1996;133:229–32.
Koehler RH, Begos D, Berger D, Carey S, LeBlanc K, Park A, Ramshaw B, Smoot R, Voeller G: Minimal adhesions to ePTFE mesh after laparoscopic ventral incisional hernia repair: reoperative findings in 65 cases. JSLS 2003;7:335–40.
La Mura F, Cirocchi R, Farinella E, Morelli U, Napolitano V, Cattorini L, Spizzirri A et al. Emergency treatment of complicated incisional hernias: a case study. Ann Surg Innov Res 2009;3:15. doi: 10.1186/1750‐1164‐3‐15.
Helgstrand F, Rosenberg J, Kehlet H, Bisgaard T. Outcomes after emergency versus elective ventral hernia repair: a prospective nationwide study. World J Surg. 2013; 37: 2273‐9. doi: 10.1007/s00268‐013‐2123‐5.
Verhelst J, Timmermans L, Van De Velde M, Jairam A, Vakalopoulos KA, Jeekel J, & Lange JF. Watchful waiting in incisional hernia: is it safe?. Surgery 2015;157:297‐303.
Helgstrand F, Rosenberg J, Kehlet H, Bisgaard T. Nationwide analysis of prolonged hospital stay and readmission after elective ventral hernia repair. Dan Med Bull 2011;58:A4322.
Helgstrand F, Jorgensen LN. The Danish Ventral Hernia Database ‐ a valuable tool for quality assessment and research. Clin Epidemiol 2016;8:719‐ 723. eCollection 2016. Review.
Helgstrand F. National results after ventral hernia repair. Dan Med J 2016;63: 1‐17.
Poole Jr GV. Mechanical factors in abdominal wound closure: the prevention of fascial dehiscence. Surgery, 1985;97:631‐640.
White TJ, Santos MC, Thompson JS: Factors affecting wound complications in repair in ventral hernias. Am Surg 1998;64:276‐280.
Turner PL, Park AE. Laparascopic repair of ventral insicional hernias: pros and cons. Surg Clin North Am 2008; 88: 85‐100, viii. doi: 10.1016/j.suc.2007.11.003.
Sanders DL, Kingsnorth An. The modern management of incisional hernias. BMJ 2012;344:e2843.
Bittner R, Bittner R, Bingener‐Casey J, Dietz U, Fabian M, Ferzli GS, Fortelny RH, et al. ʺGuidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias (International Endohernia Society (IEHS)—part 1.ʺ Surg Endosc 2014;28:353‐79.
Caglià P, Tracia A, Borzì L, Amodeo L, Tracia L, Veroux M, Amodeo C. Incisional hernia in the elderly: risk factors and clinical considerations. Int J Surg 2014;12:164‐9.
Palumbo P, Amatucci C, Perotti B, Zullino A, Dezzi C, Illuminati G, Vietri F. Outpatient repair for inguinal hernia in elderly patients: still a challenge? Int J Surg 2014;12: S4‐S7. doi: 10.1016/j.ijsu.2014.08.393.
Saber AA, Elgamal MH, Mancl TB, Norman E, Boros MJ. Advanced Age: Is it an Indication or Containdication for Laparoscopic Ventral Hernia Repair? JSLS 2008;12:46‐50.
Burger JW, Lange JF, Halm JA, Kleinrensink GJ, & Jeekel H. (2005). Incisional hernia: early complication of abdominal surgery. World J Surg 2005;29:1608‐1613.